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Category Archives: Breast Surgery

A breast lift, or mastopexy, is done to make the breasts more “perky”. Ptosis is the term used to describe droopiness of the breast, and a mastopexy reverses this process. There are three common types of mastopexy incisions:

Peri-areolar: this type of incision extends only around the areola. It may even be limited to just the upper portion of the areola if only a small crescent of skin needs to be removed (below, left).

Lollipop: A lollipop incision will correct a greater amount of ptosis than a peri-areolar incision. This type of incision starts around the nipple, then extends down the front of the breast (below, center).

Anchor-style incision: identical to the incision used in breast reduction, an anchor-style incision is essentially a lollipop incision with a horizontal incision in the crease below the breast. This will correct even very severe ptosis (below, right).

Photo credit: www.plasticsurgery.org

A small amount of breast tissue may be removed during a mastopexy to help reshape the breast mound, but this does not generally result in a visibly smaller breast.

Recovery after mastopexy is very similar to recovery after a breast reduction. Most of my patients take prescription pain medicine for the first 2 or 3 days, then transition over to ibuprofen or Tylenol. I also recommend no lifting >15lbs and no vigorous exercise during the first four weeks to allow your incisions to heal. The majority of my patients return to work within a few days unless their job requires intense physical activity.

Do you have a question about mastopexy? I will do my best to answer questions in the comments section.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Having Plastic Surgery is a big decision, and it is common for families to want to weigh in on the topic. But what do you do if your family is against you having surgery? This is actually a scenario that I see a few times a year. Before I delve in to how I help patients through this type of situation, let’s talk first about the financial aspect. Cosmetic surgery can be expensive. If your family or spouse doesn’t support your decision because they don’t think you as a family can afford it, you need to approach this like you would any big budget decision. Finances affect the entire family, so this is definitely an area where you and your spouse need to be in agreement. But if you’re single, and you are responsible for your own finances, it really doesn’t matter what other people (e.g. your grown children, friends, you parents) think. Your finances are your decision.

With that out of the way, there are two other common objections that I see family and friends make.

They worry about your health and safety. Whether you are medically a good candidate for surgery is a decision that should be made by your surgeon, possibly with input from your primary care physician. I have had family members tell me that they don’t think their mother or father is medically healthy enough to have surgery, but when I review the patient’s medical history, there is actually nothing concerning that would increase the risks of surgery. The only thing you can do here is to reassure your family that your doctor thinks you are medically healthy enough to have surgery. Seeing your family doctor for additional input may put your family’s mind at east, as this information would be coming from a trusted and known source, rather than a doctor you’ve just met.

They don’t think you need surgery. This objection comes up quite frequently. And this isn’t really surprising, because it’s a value judgement. If something bothers you, that is all that is important. Now granted, people do sometimes obsess over an area of the body that actually needs minimal improvement. And this is where your surgeon’s judgement is important. If I think that I can make a visible improvement that will make a patient happier, then I recommend surgery. But if I think that no improvement is possible or that the patient won’t be happy regardless of the results, that is not a patient I offer surgery to.

To summarize, the financial aspect of surgery is a decision that should be made as a team if you are married or otherwise share finances with someone. But if finances are solely your decision, then the opinions of other family and friends don’t matter. The other aspects of the decision to have surgery are 1) whether you are medically healthy enough, and 2) whether you’ll be able to achieve the results you want. Those parts of the decision should be made in collaboration with your surgeon and your primary care physician.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

I recently had a patient ask me if a breast reduction and a tummy tuck (abdominoplasty) could be done at the same time. I am often asked if two operations can be combined, and the answer isn’t always the same, so in today’s blog post I wanted to give you a peek into my thought process. There are several factors to consider:

Will recovery be more difficult if the two operations are combined? I won’t do a carpal tunnel release on both hands in a single surgery, for example, because during the recovery period the patient is stuck with a splint on each wrist. This makes it fairly difficult to do things like shower, feed yourself, or even use the bathroom. Along the same lines, I usually recommend splitting a brachioplasty (arm lift) and thigh lift into separate operations so that you can use your arms to compensate for the soreness in your legs, e.g. when getting up out of a chair, and vice versa.

How long with the total operation be? Several studies have shown that longer operations increase the risk of forming blood clots in the legs (deep vein thrombosis). There may be an increased risk of infection in longer operations as well, although the data here is not as clear cut. In addition, surgeon fatigue definitely plays a role. Surgeons are human, and we do get tired during long cases. In my own practice, I limit operations to around 8 hours or less when combining elective procedures.

Are the two operations considered cosmetic or covered by insurance? The hospital that I operate at will allow me to combine cosmetic and medically necessary operations. They just separate the billing, so the portion for the non-cosmetic operation goes to the insurance company. Some surgery centers will not allow surgeons to combine a cosmetic operation with one covered by insurance, however, so this may be a factor in your surgeon’s decision making process.

shutterstock.com

After reading through the information above, you’ve probably concluded that it is possible to perform a breast reduction and an abdominoplasty at the same time. And in fact, this is a fairly popular combination operation. The advantage is that you can recover from both operations at the same time, rather than having two separate recoveries.

Do you have any questions about combining operations? I would love to hear them in the comments section.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Many of the patients I see coming in for information on breast reduction surgery are overweight. In today’s blog post I am going to discuss how being overweight can affect breast size, and whether or not you should lose weight prior to considering surgery. Let’s break it down into several commonly-asked questions:

Will my breasts be smaller if I lose weight? Maybe, maybe not. Breasts are composed of both fat and glandular tissue. Younger women tend to have more glandular tissue, whereas older women tend to have more fat. If you lose weight, the amount of glandular tissue does not change, so if your breasts are largely glandular tissue, you won’t see a dramatic size decrease. In addition, everybody loses and gains weight differently. I tend to gain weight in my hips and thighs, whereas another person might gain weight in her stomach. So losing weight in and of itself is no guarantee that your breast size will decrease.

What if I lose weight after I have breast reduction surgery? The answer to this question is similar to the question above. You may or may not see a decrease in breast size if you lose weight. The more weight you lose, the more likely you are to see a change in your breast size. An if your breasts do decrease in size, they can become droopy (ptotic). I generally recommend to my patients that if they are planning on losing more than 25-30lbs, they should try to do this prior to having breast reduction surgery.

What if I’m happy at my current weight, even if I am overweight? We all have dreams, er… goals, of losing that last 10, 15, or 20lbs right? If you are considering breast reduction surgery, ask yourself honestly if you have a plan of losing weight, or if it’s just a dream. It’s okay to be happy at your current weight. But my goal as a surgeon is to perform a safe operation and minimize the risk of complications, and a patient’s weight does affect the risk of complications. A study published in Plastic and Reconstructive Surgery looked at the number of complications after breast reduction in 675 patients. They noted a significant association between body mass index (BMI) and complication rate. This complication rate increased significantly when BMI was 35.6 or larger.

In my own practice, I balance the risks of surgical complications with the benefits a patient is likely to obtain from having a breast reduction. I often ask patients with a BMI>35 to lose weight prior to surgery, especially if they have other risk factors such as diabetes or a history of smoking. There are no hard and fast rules regarding weight, but understanding a patient’s weight loss goals is an important part of the surgical decision-making process.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Pedicle reduction. This is the most common type performed. In a pedicle reduction, the nipple is left attached to the breast, and its blood flow is supplied by the underlying tissue (the pedicle).

Free nipple reduction. In a free nipple reduction, the nipple is actually removed from the breast and reattached as a skin graft.

Removing the nipple seems like a pretty drastic step, right? And it does completely remove the ability to breast feed, as all of the milk ducts are divided. So why do it? It’s a matter of blood flow. A nipple placed as a skin graft has a lower metabolic requirement (i.e. needs less oxygen and fewer nutrients) than a nipple which remains attached. So free-nipple reductions are done in cases where blood flow to the nipple might be decreased such as:

Patients with diabetes.

Patients with a heavy smoking history.

Very large breasts – in this instance the blood has to travel a long distance to reach the nipple.

But what do your breasts actually look like after a free nipple reduction? For the first week there will be a dressing over the nipple which is held on with stitches. This dressing is called a bolster, and it holds the nipple flat to the underlying tissue both to allow nutrients to diffuse into the nipple and for new blood vessels to grow into the graft.

After the dressing comes off, the nipple may undergo some superficial sloughing, which is when the outer layers of skin peel and flake off. This happens because nipples are fairly thick, and the very outer layers of skin do not get good blood flow initially. This superficial sloughing may result in some irregular pigmentation, especially in darker skinned individuals.

As the nipple graft heals over the ensuing weeks and months, the pigmentation returns. New cutaneous (skin) nerves may also grow into the graft, returning a little bit of sensation to the area. After a year of healing, the nipple graft looks very much like the nipple after a pedicle reduction, although some irregular pigmentation may persist.

Do you have any questions about free nipple grafts? Leave them in the comments and I’ll get back to you.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

Placing breast implants (augmentation) and lifting the breast (mastopexy) are each fairly straightforward operations, with a low risk of complications. But when the two procedures are combined, the risk of complications increases significantly. This is because the two operations have goals in opposition to one another.

Mastopexy:

Removes skin

image from shutterstock.com

Changes the position of the nipple

Reshapes the breast

Augmentation:

Adds weight to the breast

Stretches the skin envelope

Combining these two procedures can potentially lead to serious complications. For example, if the nipple does not have adequate blood supply after surgery it can die. The risk of this happening with either a mastopexy or an augmentation is very small, but when both are done at the same time, the blood supply to the nipple can be compromised.

Even when a mastopexy and augmentation are combined safely, the results are not always predictable. The result could be an implant that is too high or too low, or an implant that is not the right size. If this happens, a second operation is needed to correct the problem. To provide safe, reliable results, I prefer separating the two procedures in most cases. If only a very small mastopexy is done, then I will place an implant at the same time. But if a more significant lift is needed, I do the mastopexy first and let things heal for 6 months before placing breast implants. This provides a safer, more predictable result than combining the two procedures, and some patients even find they don’t need an implant after the mastopexy, because moving the breast tissue back up where it belongs gives a fuller appearance as well.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.

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I realize I’m going a little outside my “zone of expertise” by delving into the world of women’s fashion, but there is actually a really good reason for that. A large part of my practice is breast surgery: breast reductions, breast augmentations, and breast reconstructions. Patients often focus on postoperative bra size, which is very, very difficult to predict. In fact, most women are not wearing the correct size bra preoperatively. So basing your ideal bra size on the incorrect size that you’re currently wearing is simply not helpful in terms of predicting what you’ll actually look like after surgery. Today I’m going to explain how to properly measure yourself for a bra, and how surgery changes bra size.

What size bra do you wear now? If you’ve read up on measuring for bras, you know that your band size is the measurement around your chest, just under your bust, plus 4 or 5 inches (4 if it’s an even measurement, 5 if it’s an odd measurement). As an alternative, you can measure the chest circumference just over the breast, right under your armpits. So that gives you some wiggle room right there in terms of measuring incorrectly.

Photo credit: RealSimple.com

Next you need to measure your bust size, which is across the fullest part of your breast. But most women’s breasts are not perfectly perky, so you actually need to do this measurement wearing a non-padded bra.

Finally, you use these two measurements to calculate your cup size. This is the difference between the bust measurement and the band measurement. An A cup is a 1″ difference, a B cup is a 2″ difference, and so on. Real Simple magazine has a great article on how to measure bra size, which I recommend reading before you measure.

Once you have the correct measurement, you need to make sure the bra actually fits. Breasts are moving targets, so to speak, so this isn’t as simple as trying on a pair of pants. I found a fabulous blog post on putting your bra on properly, which explains how to tell if your bra fits correctly.

Now that you understand how to measure yourself for a bra, and how to tell if your bra fits, you are starting to understand why estimating postoperative bra size is so impossible:

The band size usually stays the same, but may change if any liposuction is done under the arms or over the upper back.

The cup size change depends on the change in bust size compared to the change in band size. This isn’t a straightforward calculation based on volume. A woman with a broader chest (i.e. larger band size) will need a larger volume change to change a cup size compared to a woman with a smaller chest (i.e. smaller band size).

Bra fitting is a tricky business. But as with most clothing, it’s really more important how you look and how you feel than what size you wear.

Disclaimer: This webpage is for general information only. It is not intended to diagnose or treat any medical illness, or give any specific medical advice. Because medical knowlege is constantly evolving, I cannot guarantee the accuracy or timeliness of any information in this blog.